Justification of radiographic examinations: What are the key issues?

Assessing, Advising, and Advancing the Filling Practices of the Radiology Request Form in Africa: A Systematic Review

Despite the increased use of diagnostic imaging in Africa, the completion of the Radiology Request Form (RRF) remains suboptimal, often relying on paper-based communication. To examine the practices surrounding RRF completion in the African continent, on 25 March 2024, we conducted a systematic review of peer-reviewed articles describing the practice in African settings. Non-African studies, studies involving non-human subjects, and articles examining the practice of the RRF for interventional usage were excluded. Our search involves PubMed/MEDLINE, ScienceDirect, Scopus, Web of Science, Google Scholar, and African Journals Online. The included studies were 3004, of which 30 met the inclusion criteria. These studies span eight countries and highlighted several shortcomings, including the usage of informal forms, unconventional abbreviations, illegibility, inaccuracy, and the lack of important fields from institutional forms, commonly the last menstrual period and the referrer's contact details. We also found widespread non-compliance in all RRF fields; half of the studies did not have an adequately filled form. Incomplete RRFs lead to delayed imaging, increased workloads for radiographers and radiologists, and potential misdiagnoses due to insufficient information. It will also impede the application of radiation protection principles. To address these challenges, empowering radiographers and radiologists and encouraging best practices is essential. Regular audits and educational initiatives aimed at clinicians are recommended. While transitioning to a paperless communication system might help, implementing nationwide quality improvement projects to standardise radiology request forms is currently more feasible.

Radiation Dose Optimization in Radiology: A Comprehensive Review of Safeguarding Patients and Preserving Image Fidelity

Radiation dose optimization in radiology is a critical aspect of modern healthcare, aimed at balancing the necessity of diagnostic imaging with the imperative of patient safety. This comprehensive review explores the fundamental principles, techniques, and considerations in optimizing radiation dose to safeguard patients while preserving image fidelity. Beginning with acknowledging the inherent risks associated with medical radiation exposure, the review highlights strategies such as the As Low as Reasonably Achievable (ALARA) principle, technological advancements, and quality assurance measures to minimize radiation dose without compromising diagnostic accuracy. Regulatory guidelines and the importance of patient education and informed consent are also discussed. Through a synthesis of current knowledge and emerging trends, the review underscores the pivotal role of radiation dose optimization in radiology practice. Furthermore, it emphasizes the need for ongoing research and collaboration to advance dose reduction strategies, establish standards for radiation safety, and explore personalized dose optimization approaches. By prioritizing radiation dose optimization, healthcare providers can ensure the highest standards of patient care while minimizing potential risks associated with medical radiation exposure.

Diagnostic radiographers' perceptions of professional identity in Johannesburg, Gauteng, South Africa

INTRODUCTION

The study explored and described the professional identity of diagnostic radiographers in Johannesburg, Gauteng, South Africa.

METHODS

The methodology employed for the study was qualitative, exploratory and descriptive design. Face-to-face interviews were conducted with thirteen diagnostic radiographers from private, public practices and individually owned practices. Semi-structured interviews were conducted, and the responses underwent thematic analysis and used Braun and Clarke's six steps for analysing qualitative data.

RESULTS

The thematic analysis revealed three themes and six categories. The three themes identified were: perceptions of identity, environment influences and organisational institutions.

CONCLUSION

This study provided an insight into the current perspectives of the professional identity of diagnostic radiographers in Johannesburg, South Africa, which reflected a positive professional identity. The three themes identified could inform guidelines for education in diagnostic radiographers' professional identity in the future.

Radiographers' role in justification of medical imaging examinations

INTRODUCTION

Justification is one of the fundamental principles in radiation protection and according to the ICRP, justification means that any decision that alters the radiation exposure situation should do more good than harm. The purpose of this study was to explore diagnostic radiographers' attitude towards their role in justification, and to assess the perceived need for justification discussions with peers and the ability to reject unjustified referrals during day, evening, and night shifts.

METHODS

This study was conducted in Norway and Denmark. A questionnaire was developed in Norwegian and translated into Danish, and two experienced radiographers assessed content validity. A secure online data capture solution was used, and the questionnaire was distributed to radiographers working in clinical settings in March and April 2022 (n = 1215).

RESULTS

A total of 202 radiographers were included in the study, 93 from Norway and 109 from Denmark, respectively. Seventy-nine per cent of the radiographers reported that they had a duty to assess justification and 86 % did so daily. Their role in justification assessment was reported as relatively important, where CT and MRI had significantly different results than the total respondents. Radiologists were designated as being most responsible in the assessment, closely followed by referring doctors and radiographers. The most important criterion for justification assessment was the referring doctor's clinical assessment. The need to confer was highest during daytime when there were also more opportunities to confer.

CONCLUSION

The need to discuss justification of examinations is greater during daytime when access to radiologists is also high, while both access and need are low during night shifts. Further research is needed to explain the latter finding. Radiographers who engage in daily justification assessments, and perceive it as a duty, find justification important and report having sufficient knowledge to carry out these assessments.

The radiographers' opinion on assessing radiological referrals

INTRODUCTION

Radiographers have a fundamental duty to assess radiological referrals and ensure imaging is justified. This study constitutes the third part of a broader research on radiographers' assessment of referrals. The study examines the opinions of radiographers on the matter, as articulated in their own words.

METHODS

A questionnaire with closed and open-ended questions was designed, validated, and distributed to radiographers following activities organised by the International Society of Radiographers and Radiological Technologists (ISRRT). This third part covers the participants' free-text comments about radiographers' assessment of referrals. Qualitative, inductive content analysis was used to report findings involving three phases: 1) Preparation, 2) Organisation where two authors individually coded and categorised the emerged themes, and 3) Reporting, were the authors compared, reviewed, and defined the meanings of the themes and sub-themes.

RESULTS

Five main themes Opportunity, Competency, Work environment, Role perception and Significance emerged, shaped as descriptive, normative, and prospective statements. In opportunities the respondents (descriptively) depicted the importance of their position and challenges faced, including lack of adequate clinical information in referrals. Competencies concerned whether they have the required knowledge and skills for the task. In work environment the respondents viewed themselves as partners and collaborators with radiologists and referrers but expressed that unclear regulations could challenge their task. In role perception, the respondents expressed (normatively) that assessing referrals is vital for professional self-esteem and radiographers' responsibility. Significance covers the importance of assessing referrals for different aspects relating to quality of services.

CONCLUSION

Radiographers expressed high engagement towards tasks of assessing referrals. To support radiographers in this role, it is crucial to establish clear regulations, better organisation of departmental processes and provide adequate training.

IMPLICATIONS FOR PRACTICE

Radiology departments should actively explore strategies of incorporating the radiographers' resources and core position in the process of assessing referrals, in a consistent and effective manner.

Australian radiographer roles in the emergency department; evidence of regulatory compliance to improve patient safety - A narrative review

OBJECTIVES

Using a narrative approach, this paper aims to determine the extent of Australian radiographers' regulatory compliance to improve patient safety when performing appendicular X-ray and non-contrast brain computed tomography (CT) in the Emergency Department (ED).

KEY FINDINGS

A narrative review explored relevant literature and key regulatory policy. Ten documents were identified, three main themes were developed related to the radiographer roles in X-ray request justification, dose optimisation and preliminary image evaluation (PIE). Radiographers were equally aware of justification and optimisation pre and post the introduction of a Medical Code of Practice. The collective PIE accuracy of radiographers remained unaffected by changes in mode of PIE delivery and regulatory factors but varied based on the anatomical region.

CONCLUSION

While current Australian regulations mandate radiographer request justification, dose optimisation and PIE, the degree of compliance by Australian radiographers remains uncertain. Current literature provides evidence that radiographers can improve patient care and safety through justification, optimisation, and PIE delivery. Change in workplace practice, supported by key stakeholders including radiologists, is essential to integrate radiographers' functions into routine ED clinical practice. Further research is required to audit radiographers' regulatory compliance to improve patient safety.

IMPLICATIONS FOR PRACTICE

Patient safety in ED can be improved with timely and accurate diagnosis provided by radiographers. Radiographers have a professional obligation to adhere to the capabilities and standards for safe medical radiation practice defined by Australian regulations. Therefore, radiographers must justify the X-ray request, optimise the radiation dose where appropriate and communicate urgent or unexpected findings to the referrer.

Looking for appropriateness in follow-up CT of oncologic patients: Results from a cross-sectional study

PURPOSE

The objective of this study was to assess the inappropriateness rate of oncological follow-up CT examinations.

METHODS

Out of 7.000 oncology patients referred for follow-up CT examinations between March and October 2022, a random sample of 10 % was included. Radiology residents assessed the appropriateness using the Italian Society of Medical Oncology (AIOM) guidelines, supervised by senior radiologists. Association between inappropriateness and clinical variables was investigated and variables influencing inappropriateness were analyzed through a binary logistic regression.

RESULTS

Three-hundred-eighty-eight examinations (56.1 %) were consistent with AIOM guidelines. An additional 100 (14.5  %) examinations did not follow the recommended schedule but were nevertheless considered appropriate because of suspected recurrence/progression (10.7 %) or adverse event requiring imaging assessment (3.8 %). Two-hundred-four (29.4 %) examinations were rated as inappropriate. Inappropriateness causes were as follows: CT not included in the relevant guideline (n = 47); CT extended to additional anatomical regions (n = 59); CT requested at a shorter time-interval (n = 98). No statistically significant difference was found in age, sex, scan region, and primary cancer between appropriate and inappropriate examinations. The only variable significantly associated with inappropriateness was being referred by a specific hospital unit named "unit 2" in the study (p = 0.009), which was demonstrated to be the only appropriateness independent predictor (OR 1.952).

CONCLUSION

This study shows that majority of oncological patients referred for follow-up CT follows standard guidelines. However, a non-negligible proportion was rated as inappropriate, mainly due to the shorter time-interval. No clinical variable was associated with inappropriateness, except for referral by a specific hospital unit.

Clinical indications for plain abdominal radiographs: A survey study among radiographers

Background

Abdominal pain is a common complaint in the Emergency Department. Radiographers' knowledge and practices regarding clinical indications for performing abdominal examinations are crucial in the results radiographs produced.

Aim

To determine the knowledge and practices of radiographers regarding the clinical indications for performing radiographic examinations of the abdomen.

Setting

Four public hospitals in the Eastern Cape province, South Africa.

Methods

A cross-sectional study was conducted, using a convenience, all-inclusive sample of n = 85 radiographers. A hard copy self-administered questionnaire was distributed between February and June 2020. Descriptive (mean and standard deviations) and inferential (chi² test) statistics were generated using IBM® SPSS® version 26.0 software package.

Results

Knowledge of clinical indications had a mean of 59.41. All four demographics (age, years of experience, attended a short course and attended pattern recognition course) were significantly associated with overall knowledge. Additionally, short course attendance was significantly associated with most practice items, and two knowledge items (which views are done for perforation; and which view(s) demonstrate a stab abdomen). Pattern recognition was significantly associated with one knowledge item (which views are regarded as an acute abdomen).

Conclusion

Despite the lack of short courses and pattern recognition courses, radiographers' knowledge of clinical indications was good (>50%). Continuous training, accessible protocols for performing clinical indications for plain abdominal radiographic examinations for radiographers, audit, feedback and reminders to enhance protocol adherence are recommended.

Contribution

The study findings could be used to enhance knowledge and practices regarding clinical indications for plain abdominal radiographic examinations among radiographers.

Vetting of medical imaging referrals: A scoping review of the radiographers' role

INTRODUCTION

Vetting and treatment verification, are now an expectation of threshold radiography competencies at qualification. Radiographer-led vetting contributes to the expedition of patients' treatment and management. However, the current state and the role of the radiographer in vetting medical imaging referrals remains unclear. This review aims to explore the current state and associated challenges to a radiographer-led vetting and offer directions for future research by addressing knowledge gaps.

METHOD

The Arksey and O'Malley methodological framework was employed for this review. This includes a comprehensive search using key terms relating to radiographer-led vetting across relevant databases: Medline, PubMed, AMED and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Articles were screened for eligibility and information extracted and analysed descriptively to map the available evidence.

RESULTS

1149 studies were identified with 12 articles included for this review after duplicates were removed. The findings indicate existence of some radiographer-led vetting activities in practice; however, the scope of this practice is associated with a large variance across settings. Key challenges relating to radiographer-led vetting include referral selectivity, medical professional dominance, and lack of clinical indication on referrals.

CONCLUSION

Radiographers vet various categories of referrals depending on jurisdictional policies and more clarity in regulation, advanced practice training and change in workplace culture is needed to support radiographer-led vetting.

IMPLICATION FOR PRACTICE

Radiographer-led vetting should be championed across settings through formalised training to widen the scope of advance practice and career progression pathways for radiographers as a means of ensuring optimal use of resources.

Justification of radiological procedures: Radiographers' experiences at two public hospitals

BACKGROUND

Justification is a process conducted by the radiographer in consultation with the radiologist to evaluate radiological procedures ordered by doctors. The main purpose for justifying all radiologic procedures is to assess the benefits and risks of a requested radiographic procedure and determine whether exposure will continue. Furthermore, justification helps to prevent unnecessary radiation exposure and reduce the chances of harmful effects of ionizing radiation.

OBJECTIVES

The study aimed to explore the experiences of radiographers regarding the justification of radiological procedures at two public hospitals in Namibia METHODS: This study made use of a qualitative, exploratory design. A total number of 13 purposefully selected radiographers from radiology departments in two tertiary public - hospitals in Namibia were interviewed using a semi-structured interview guide and audio recorder. All interviews were conducted face-to-face until data saturation was achieved. Data were analysed using Atlas.ti Windows (version 9.0 using Tesch's 8-step method of qualitative data analysis to generate themes and subthemes.

FINDINGS

The participants experienced an enhancement of patient care through enhanced radiation protection and optimised patient care. They also experienced defunct communication systems through deficient communication between radiographers and referrers, professional role conflict and incomplete referrals.

CONCLUSION

The study revealed that the justification of radiological procedures was linked to both negative and positive experiences. Enhanced patient-centred care was a positive experience related to the radiographers' job responsibilities. The defunct communication support system was a negative experience as it related to the limited availability and utilisation of communication systems that are meant to enhance and support justification by radiographers. The study recommends an in-depth study to quantify unjustified procedures in these two hospital departments. Continuous professional development focusing on justification and referral protocols must be conducted jointly between radiographers and referrers to create awareness and a platform for shared decision-making models.

Service evaluation of radiographer-led vetting and protocoling of Computed Tomography (CT) scan requests in a Singapore public healthcare institution

INTRODUCTION

A service improvement project involving the vetting and protocoling of Computed Tomography (CT) scan requests by qualified CT radiographers was initiated in 2018.

AIM

This study provides a comprehensive evaluation of how a radiographer-led initiative aims to ensure that the CT scan requests received by the Radiology department are clinically appropriate, which in turn will reduce interruptions to the interpretation and reporting of imaging examinations by radiologists, who might otherwise be required to attend to clinically inappropriate and wrongly protocolled CT scan requests.

METHOD

Outpatient CT scan requests received from July to October 2021 were vetted and protocolled by a qualified CT-trained radiographer for parameters which included the appropriateness of the clinical indication, adequacy of patient preparation for the scan, as well as the suitability of the requested examination protocol pertaining to the need for contrast media, multiple contrast-enhanced imaging phases, and the appropriateness of the scan range.

RESULTS

Poor patient preparation and insufficient or inaccurate clinical indications were the most common findings during the vetting process (71%). Out of the 64 CT scan requests with protocol errors, 77% were attributed to contrast media type errors. The odds of incorrect CT scan requests increased with the requesting clinician's rank, while there was no such significant correlation with the clinical specialty of the requesting clinician or the CT scan type.

CONCLUSION

The meticulous vetting of imaging requests helps to ensure that limited imaging hardware resources are allocated to more clinically appropriate cases, correct protocols are applied to requested imaging scans, and that patients undergoing imaging are adequately prepared, thereby enhancing overall patient care.

IMPLICATIONS FOR PRACTICE

Vetting of imaging requests by radiographers, who are capable to make appropriate clinical decisions related to their enhanced level of practice ensures patient safety and optimisation of Radiology resources.

The value of referral information and assessment - a cross sectional study of radiographers' perceptions

Background

Radiology professionals are frequently confronted with referrals containing insufficient clinical information, which hinders delivery of safe and quality medical imaging services. There is however lack of knowledge on why and how referral information is important for radiographers in clinical practice. This study explores what purposes referral information is used/ useful for the radiographers, and the benefits of involving them in assessing referrals.

Methods

A cross sectional study was conducted of radiographers recruited through the International Society of Radiographers and Radiological Technologists (ISRRT) networks. A questionnaire was developed and distributed consisting of 5-point Likert scale questions on a) use/usefulness of referral information for 12 listed purposes and b) the benefits of radiographers assessing referrals for 8 possible reasons. The questionnaire was validated using a test–retest reliability analysis. Kappa values ≥0.6 were accepted. SPSS software was used for data analysis and chi-square tests to determine associations between using referral information and background variables.

Results

Total respondents were 279 (n = 233 currently in clinical practice and n = 46 in other positions). The participants in clinical practice ranked high all 12 listed purposes for use of referral information, and all except one received ≥60% ‘frequent’/‘very frequent’ responses. Use for patient identification purposes received the highest score (97% ‘frequently’/‘very frequently’ responses), followed by ensuring imaging of the correct body region (79% ‘very frequently’ responses). Radiographers not currently working in clinical practice ranked the ‘usefulness’ of listed items similarly. Significant associations between frequent use of referral information and education level were not observed, and only three items were significantly associated with modality of practice. All items on benefits of radiographers assessing referrals received ≥75% ‘agree’/‘strongly agree’ scores. The items ranked highest were promotes radiographers’ professional responsibility and improves collaboration with radiologists and referring clinicians, with 72 and 67% strongly agreed responses, respectively.

Conclusion

Radiographers use referral information frequently for several purposes. The referral information is needed for justifying and optimising radiological procedures, hence crucial for ensuring patient safety and high-quality services. This further emphasis why radiographers perceive several benefits of being involved in assessing the referral information.

Factors affecting chiropractor requests for full-length spinal radiography: A scoping review

Chiropractors often refer their patients for full-length (three- to four-region) radiographs of the spine as part of their clinical assessment, which are frequently completed by radiographers in medical imaging practices. Overuse of spinal radiography by chiropractors has previously been reported and remains a contentious issue. The purpose of this scoping review was to explore the issues surrounding the utilisation of full-length spinal radiography by chiropractors and examine the alignment of this practice with current evidence. A search of four databases (AMED, EMBASE, MedLine and Scopus) and a hand search of Google was conducted using keywords. Articles were screened against an inclusion/exclusion criterion for relevance. Themes and findings were extracted from eligible articles, and evidence was synthesised using a narrative approach. In total, 25 articles were identified, five major themes were extracted, and subsequent conclusions drawn by authors were charted to identify confluent findings. This review identified a paucity of literature addressing this issue and an underrepresentation of relevant perspectives from radiographers. Several issues surrounding the use of full-length spinal radiography by chiropractors were identified and examined, including barriers to the adherence of published guidelines for spinal imaging, an absence of a reporting mechanism for the utilisation of spinal radiography in chiropractic and the existence of a spectrum of beliefs amongst chiropractors about the clinical utility and limitations of full-length spinal radiography. Further investigation is required to further understand the scope of this issue and its impacts for radiation protection and patient safety.

Paediatric minor head injury applied to Paediatric Emergency Care Applied Research Network CT recommendations: An audit

Background

Traumatic brain injury (TBI) is a common cause of paediatric morbidity and mortality, with higher TBI rates in low- and middle-income countries. Non-contrast brain CT is the gold standard for diagnosing intracranial injuries; however, it exposes patients to ionising radiation. The Paediatric Emergency Care Applied Research Network (PECARN) clinical decision rule (CDR) aids clinicians in their decision-making processes whilst deciding whether a patient at very low risk of a clinically important TBI (ciTBI) requires a CT scan.

Objectives

To establish whether the introduction of the PECARN CDR would affect CT utilisation rates for paediatric patients presenting with minor blunt head injuries to an academic hospital in Gauteng, South Africa.

Method

This was an audit of paediatric patients who presented with minor blunt head injuries and were referred for CT imaging at an academic hospital in Gauteng, compared with PECARN CDR recommendations, over a 1-year period.

Results

A total of 100 patients were referred for CT imaging. Twenty patients were classified as very low risk, none of whom had any CT findings of a TBI or ciTBI (p < 0.01). A total of 61 patients were classified as intermediate risk and 19 as high risk. In all, 23% of the intermediate and 47% of the high-risk patients had CT features of a TBI, whilst 8% and 37% had a ciTBI, respectively.

Conclusion

Computed tomography brain imaging may be omitted in patients classified as very low risk without missing a clinically important TBI. Implementing the PECARN CDR in appropriate patients would reduce CT utilisation rates.

Using the theory of planned behaviour to determine radiation protection among South African diagnostic radiographers: a cross-sectional survey

INTRODUCTION

The use of ionising radiation in medicine accounts for the majority of radiation exposure from artificial sources. Therefore, all measures to safeguard against unnecessary radiation exposure must be taken. As radiographers are central to radiation protection, this study aimed to determine South African radiographers' attitude towards radiation protection, subjective norm and perceived behavioural control concerning radiation protection.

METHODS

This quantitative cross-sectional study used an online theory of a planned behaviour radiation protection questionnaire shared through social media platforms from August 2019 to February 2020. Diagnostic radiographers registered with the Health Professions Council of South Africa and employed at radiology departments in South Africa were invited to participate in the study.

RESULTS

Four hundred and seventeen radiographers in South Africa responded to the questionnaire. The majority of respondents (90%, n = 376) plan to use radiation protection; however, only 16% continuously used radiation protection in the past. Respondents felt that using radiation protection was extremely good (72.2%), pleasant (47%), beneficial (74.1%), rewarding (55.2%) and worth the time (52.5%); 57% of respondents indicated that using radiation protection takes longer to complete the examination. Respondents report that approval from patients (43.5%), patients' family (32%), radiographer coworkers (31%), radiology managers (47%) and radiologists (43.9%) is very much important to them.

CONCLUSION

The study shows that even though fewer respondents use radiation protection at present, most respondents plan and intend to use radiation protection measures. Respondents felt that radiation protection was good and beneficial, with some respondents feeling that radiation protection is not worth the time, which coincide with lengthening the examination. Overall, South African radiographers' attitudes towards radiation protection, subjective norm, perceived behavioural control and radiation protection intention were high.

South African radiographers' radiation protection practices, a qualitative study

INTRODUCTION

Radiation protection is multifarious, and consequently, a radiographers' application of radiation protection is multifaceted. Studies have shown varying radiation protection practices among radiographers. The first quantitative phase of this explanatory, sequential mixed-method study used the theory of planned behaviour to explore South African radiographers' radiation protection behaviour. Overall, South African radiographers' attitudes to radiation protection, subjective norm, perceived behavioural control, and radiation protection intention was high. This second phase of the study aimed to explore the reasons for South African radiographers' radiation protection practices.

METHODS

This study used an exploratory and descriptive qualitative approach. Data was collected through 13 in-depth semi-structured telephone interviews. Thematic analysis was used in order to uncover original phenomena. Data saturation was achieved and the study adhered to trustworthiness and ethical measures.

RESULTS

Thematic analysis identified two themes. The participants had the appropriate radiation protection knowledge, but radiation protection compliance remained a personal choice. Impediments such as feeling rushed during imaging of trauma and challenging patients, patients knowledge of radiation protection, resources, imaging referrals, inadequate training when transitioning from analogue to digital radiography and managerial support contributed to radiation protection compliance. Strategies such as further education, research and a change in mindset were suggested to further foster radiation protection compliance.

CONCLUSION

Even though participants' knowledge of radiation protection aligned with the legislated guidelines, limited internalising of the knowledge resulted in compliance being a personal choice. Participants reflected on their insouciant attitude and observed a similar attitude in their radiographer colleagues. Patient and work-related impediments were identified to contribute to radiation protection compliance. Strategies to further foster compliance were suggested.

IMPLICATIONS FOR PRACTICE

Understanding the reasons for radiographers' choice in radiation protection will allow the development of strategies that foster optimum application of radiation protection practises. Developing a radiation protection culture that enhances personal compliance supported by education and evidence should be considered.

Radiographers' actions and challenges when confronted with inappropriate radiology referrals

OBJECTIVES

To explore radiographers' actions toward inappropriate referrals and hindrances to assessing referrals.

METHODS

An online survey was distributed to radiographers via the International Society of Radiographers and Radiological Technologists (ISRRT) networks. The questionnaire consisted of 5-point Likert scale questions on radiographers' actions to supplement referral information, actions for unjustified referrals and hindrances to referral assessment. The questionnaire was validated using a test-retest reliability analysis. Kappa values ≥ 0.6 were accepted. SPSS software was used for data analysis and chi-square tests to compare subgroups.

RESULTS

Total responses received were 279. The most reported actions to supplement missing referral information were to ask the patient or relative, examine the body region of concern and check medical records (73%, 70%, 67%, responded often/always, respectively). The actions when confronted with unjustified referrals were reported equally to consult the radiologist, referring clinician and radiographer (69-68% often/always responses). The hindering factors ranked high (agreed/strongly agreed responses) pertained to inadequate information in referral forms (83%), ineffective communication among healthcare professionals (79%), lack of training (70%) and allocated time (61%). Statistically significant associations were observed for a few actions and hindrances with education level, modality of practice and responsibility to screen imaging referrals.

CONCLUSION

Radiographers consult colleagues about suspected unjustified referrals. Effective communication pathways, training and time allocation to improve radiographers' skills to assess referrals may enhance appropriate imaging and delivery of quality patient care.

KEY POINTS

• Radiographers' actions of supplementing missing information in radiology referrals facilitate provision of high-quality health services. • Radiographers' strategy when confronted with inappropriate referrals is to consult radiologists and referring clinicians. • Better inter-professional communication and organisation of tasks can facilitate radiographers' participation in referral assessment to ensure appropriate imaging.

Workplace factors facilitating the radiographers' assessment of referrals for diagnostic imaging - A qualitative study

INTRODUCTION

Radiology referrals are assessed for appropriate imaging based on the available clinical information. The task is legally the responsibility of the radiologists but could be delegated to radiographers under guidance. Knowledge of how this task is organised in radiology departments is limited. The study aim was to identify workplace factors facilitating the radiographers' assessment of referrals for medical imaging.

METHODS

Five radiographers were recruited by convenience- and snowball-sampling techniques through the online social media platform LinkedIn. The participants represented different private and public hospitals and had from three to above ten years of experience with assessment of referrals for plain and cross sectional imaging. Following a qualitative approach, 60-min in-depth semi-structured interviews were conducted through online video meetings. Interviews followed a topic guide with 15 questions and 20 keywords, previously tested through a pilot interview. Systematic text condensation was performed using NVivo 12, where central themes and underlying subthemes were developed.

RESULTS

Five central facilitating factors were identified, each with subthemes identified as: (1) Formal responsibilities; Documented delegation, Specific role description, (2) Training; Achieving skills, Maintaining skills, (3) Guidelines; Clinical indications, Priority, (4) Resource allocation; Time, Staff, (5) a Supporting environment; Teamwork, Mutual benefits, Feedback and knowledge sharing.

CONCLUSION

The study adds new and valuable insights into workplace factors facilitating the radiographers' delegated task of assessing referrals. Workflows adapting such factors benefit radiographers by increasing knowledge and professional development, while positively re-allocating radiologist resources.

IMPLICATIONS FOR PRACTICE

The study findings may support radiology workplaces in establishing or improving referral assessment by radiographers. Subsequently, improved quality of patient services may be achieved.

Perceptions of radiographers regarding establishing a self-regulatory body for radiation safety in Eswatini

INTRODUCTION

Eswatini remains one of the countries in Southern Africa without a regulating authority for radiation safety in the radiography departments. Quality control (QC) tests and radiation protection practices are unmonitored. This study sought to explore radiographers' perceptions regarding establishing a self-regulatory body that will formulate, implement and monitor compliance of standardised guidelines for radiation safety.

METHODS

A qualitative, exploratory and descriptive research approach was undertaken. Radiographers currently registered and practicing in Eswatini were purposively selected and invited to participate. Data was collected using semi-structured interviews. Audiotapes and field notes were used. Audio taped interviews were transcribed verbatim and then analyzed using qualitative content analysis.

RESULTS

Six themes emerged from the analysis of data, namely; a) awareness of the need for QC tests, b) radiation protection and safety in the radiography departments, c) radiographers' responsibility towards radiation protection, d) education and training in radiation safety for radiographers and other stakeholders, e) support from governmental and management structures and f) the need for the self-regulatory body in the radiography departments.

CONCLUSION

The study demonstrated that there is awareness among radiographers in Eswatini that radiation safety practices are necessary in the radiography departments. Continuous education and training were deemed as imperative to improve radiation safety in the radiography departments. There is also support for the idea of establishing the self-regulatory body.

IMPLICATIONS FOR PRACTICE

The need for monitoring structures in order to ensure radiation safety in the radiography departments is highlighted in this study. Government officials and hospital management are crucial in ensuring radiation safety in radiography departments.

Knowledge of radiation protection among radiology professionals and students: A medical college-based study

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The overall knowledge of radiation protection among radiology professional and students was adequate.

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The knowledge of radiation protection among diploma graduate was inadequate.

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Radiation protection law should be promulgated as soon as possible in Nepal.

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This is the first study to perform principal component analysis in the research study of its kind.

BACKGROUND

Radiation protection is the core of radiography for safe radiation-based imaging practice. This study aims to determine the knowledge of radiation protection among radiology professionals and students in a medical college of Nepal.

MATERIAL AND METHODS

A questionnaire survey was carried out among 35 radiology staff and students at Universal College of Medical Sciences (UCMS), Bhairahawa, Nepal. The questionnaire survey consisted of socio-demographic variables and 17 questions, 3 questions were related to general information regarding training, knowledge, and experience and the remaining 14 multiple choice questions (MCQ) were related to radiation protection. Data were analyzed in SPSS Statistics software, version 27. The p-value was set at 5% level of significance. Nonparametric tests were applied since the data did not follow normal distribution. The knowledge score were categorized into lesser than 60 % inadequate, 60–80 % adequate and greater than or equal to 80 % excellent.

RESULTS

Out of total 35 participants, 28 were male and 7 were female with mean age 26.09 ± 7.18 years, range 18–54. The average radiation level of awareness was 9.6 (68.57 %), which was adequate, maximum 13 and minimum 4. There was not statistical significance of knowledge score by gender, age groups, work experience and studentship. Taking academic qualification, the level of knowledge of diploma graduates was inadequate 7.76 (55.42 %), and lower than other higher academic qualifications.

CONCLUSIONS

Adequate radiation protection course materials and training should be introduced for diploma graduates. Continuing professional education (CME) should be organized regularly. Moreover, radiation protection law is a must in Nepal now.

An assessment of medical students' proficiency regarding the hazards of radiological examinations on the health of workers and patients: a cross-sectional study from Palestine

BACKGROUND

The use of radiological examination is increasing worldwide. Since radiation exposure can result in many health hazards, medical professionals, as well as medical students, should possess adequate knowledge regarding radiation and its related hazards to protect themselves and the patients. Many studies have assessed medical students' knowledge on this topic, but never in Palestine. In this study, we aimed to examine Palestinian medical students' awareness and knowledge regarding radiological examination modalities and their risks on themselves and their patients.

METHODS

This was an observational, cross-sectional, population-based study, conducted to assess the awareness of radiation exposure and its risks among Palestinian medical students. An online questionnaire was implemented on medical students at An-Najah National University. A total knowledge score that ranged from 0 to 22 was calculated for each participant, with higher scores indicating better knowledge regarding radiation doses and the related hazards.

RESULTS

Two hundred eighty and seven students participated in our study, with a response rate of 71%. The average knowledge score of the participants was 10.97 ± 4.31 out of a maximum of 22 points. Male participants and participants in advanced study years achieved better knowledge scores (p-values were 0.034 and < 0.001, respectively). Perceived radiology knowledge was significantly associated with the actual knowledge score among the participants (p-value< 0.001). Receiving radiology lectures in fourth and fifth years significantly affected the participants' knowledge score (p-values were < 0.001).

CONCLUSIONS

We found a severe lack of knowledge regarding radiation doses and related risks among medical students. Therefore, we recommend that medical schools update and supplement their curriculum regarding knowledge on radiation.

Investigation of radiation protection and safety measures in Rwandan public hospitals: Readiness for the implementation of the new regulations

BACKGROUND

An essential concept that all radiographers are required to implement is the use of techniques and the provision of protective devices to minimize radiation to patients and staff. Methods to achieve this could include good communication, immobilization, beam limitation, justification for radiation exposure, shielding, appropriate distances and optimum radiographic exposures factors.

PURPOSE

The aim of this study was to assess the availability and utilization of radiation protection and safety measures by medical imaging technologists (MITs) in Rwandan hospitals.

METHODS

A quantitative, non-experimental descriptive design was used and data collected by means of a self-designed questionnaire. One hundred and sixteen MITs (n = 116) representing 96.67% of the total population participated in the study.

RESULTS

The study found radiation safety measures were not adequately implemented in government hospitals. Only 58.62% of MITs had radiation-measuring devices, with 29% receiving dose readings inconsistently. Lead rubber aprons were available at 99.13% of the hospitals; however, 59% of the participants had never checked the integrity of the aprons. Lead rubber aprons and lead equivalent barriers were most prevalent in the facilities.

CONCLUSION

The study found there was a lack of adequate radiation safety equipment. Exposure charts and immobilization devices were not adequately implemented in the hospitals. The level of education and experience of the MITs did not appear to influence the radiation safety practice significantly. There is a need for concerted efforts between the Rwanda Utilities Regulatory Authority (RURA), Ministry of Health, University of Rwanda and hospital management to improve the radiation safety culture, especially in view of the law governing radiation protection that was recently promulgated.

Justification and optimization of radiation exposures: a new framework to aggregate arbitrary detriments and benefits

Myriad radiation effects, including benefits and detriments, complicate justifying and optimizing radiation exposures. The purpose of this study was to develop a comprehensive conceptual framework and corresponding quantitative methods to aggregate the detriments and benefits of radiation exposures to individuals, groups, and populations. In this study, concepts from the ICRP for low dose were integrated with clinical techniques focused on high dose to develop a comprehensive figure of merit (FOM) that takes into account arbitrary host- and exposure-related factors, endpoints, and time points. The study built on existing methods with three new capabilities: application to individuals, groups, and populations; extension to arbitrary numbers and types of endpoints; and inclusion of limitation, where relevant. The FOM was applied to three illustrative exposure situations: emergency response, diagnostic imaging, and cancer radiotherapy, to evaluate its utility in diverse settings. The example application to radiation protection revealed the FOM's utility in optimizing the benefits and risks to a population while keeping individual exposures below applicable regulatory limits. Examples in diagnostic imaging and cancer radiotherapy demonstrated the FOM's utility for guiding population- and patient-specific decisions in medical applications. The major finding of this work is that it is possible to quantitatively combine the benefits and detriments of any radiation exposure situation involving an individual or population to perform cost-effectiveness analyses using the ICRP key principles of radiation protection. This FOM fills a chronic gap in the application of radiation-protection theory, i.e., limitations of generalized frameworks to algorithmically justify and optimize radiation exposures. This new framework potentially enhances objective optimization and justification, especially in complex exposure situations.

Knowledge translation: Radiographers compared to other healthcare professionals

OBJECTIVES

This narrative review examines the current status of evidence-based practice and knowledge translation in diagnostic radiography. It explores knowledge translation efforts in the allied health professions aimed at systematically implementing evidence-based practice and suggests ways that these may be applied within diagnostic radiography.

KEY FINDINGS

Knowledge translation in diagnostic radiography is in its infancy with numerous examples of key findings of rigorous studies not implemented in practice. Utilising frameworks, models and theories to systematically translate knowledge into evidence-based practice has been shown to be effective in other allied health professions. Whilst few studies in diagnostic radiography report utilising these systematic approaches to implementing evidence-based practice, those that do, show promising results. Attitudes towards evidence-based practice within diagnostic radiography are becoming more positive and it is important to use this positive shift in attitudes to create real evidence-based change in the profession.

CONCLUSION

The potential benefits of systematically translating knowledge into evidence-based practice in diagnostic radiography are wide reaching with positive implications for our patients, the profession and wider community. Leaders at all levels of radiography must work towards implementing evidence-based practice in their daily work.

IMPLICATIONS FOR PRACTICE

Systematic approaches to knowledge translation should be adopted and reported in diagnostic radiography in order to more effectively translate knowledge into evidence-based practice.

Unified Open Hardware Platform for Digital X-Ray Devices; its Conceptual Model and First Implementation

Background: Digital radiography devices are still the gold standard for diagnosis or therapy guidance in medicine. Despite the similarities between all direct digital x-ray systems, researchers and new companies face significant challenges during the development phase of innovative x-ray devices; each component is manufactured independently, guidance towards device integration from manufacturers is limited, global standards for device integration is lacking. Method: In scope of this study a plug-integrate-play (PIP) conceptual model for x-ray imaging system is introduced and implemented as an open hardware platform, SyncBox. The researchers are free to select each individual device component from different vendors based on their intended application and target performance are utilized in criteria. Result: As its first implementation, SyncBox and its platform a full body high resolution radiographic scanner that employs a novel TDI digital detector. Conclusion: We believe that SyncBox has a potential for introducing an open source hardware platform to x-ray equipment design.

Radiographic image interpretation by Australian radiographers: a systematic review

INTRODUCTION

Radiographer image evaluation methods such as the preliminary image evaluation (PIE), a formal comment describing radiographers' findings in radiological images, are embedded in the contemporary radiographer role within Australia. However, perceptions surrounding both the capacity for Australian radiographers to adopt PIE and the barriers to its implementation are highly variable and seldom evidence-based. This paper systematically reviews the literature to examine radiographic image interpretation by Australian radiographers and the barriers to implementation.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses were used to systematically review articles via Scopus, Ovid MEDLINE, PubMed, ScienceDirect and Informit. Articles were deemed eligible for inclusion if they were English language, peer-reviewed and explored radiographic image interpretation by radiographers in the context of the Australian healthcare system. Letters to the editor, opinion pieces, reviews and reports were excluded.

RESULTS

A total of 926 studies were screened for relevance, 19 articles met the inclusion criteria. The 19 articles consisted of 11 cohort studies, seven cross-sectional surveys and one randomised control trial. Studies exploring radiographers' image interpretation performance utilised a variety of methodological designs with accuracy, sensitivity and specificity values ranging from 57 to 98%, 45 to 98% and 68 to 98%, respectively. Primary barriers to radiographic image evaluation by radiographers included lack of accessible educational resources and support from both radiologists and radiographers.

CONCLUSION

Australian radiographers can undertake PIE; however, educational and clinical support barriers limit implementation. Access to targeted education and a clear definition of radiographers' image evaluation role may drive a wider acceptance of radiographer image evaluation in Australia.

Bayesian Approach to Predicting Acute Appendicitis Using Ultrasonographic and Clinical Variables in Children

Objectives

Ultrasound has an established role in the diagnostic pathway for children with suspected appendicitis. Relevant clinical information can influence the diagnostic probability and reporting of ultrasound findings. A Bayesian network (BN) is a directed acyclic graph (DAG) representing variables as nodes connected by directional arrows permitting visualisation of their relationships. This research developed a BN model with ultrasonographic and clinical variables to predict acute appendicitis in children.

Methods

A DAG was designed through a hybrid method based on expert opinion and a review of literature to define the model structure; and the discretisation and weighting of identified variables were calculated using principal components analysis, which also informed the conditional probability table of nodes.

Results

The acute appendicitis target node was designated as an outcome of interest influenced by four sub-models, including Ultrasound Index, Clinical History, Physical Assessment, and Diagnostic Tests. These sub-models included four sonographic, three blood-test, and six clinical variables. The BN was scenario tested and evaluated for face, predictive, and content validity. A lack of similar networks complicated concurrent and convergent validity evaluation.

Conclusions

To our knowledge, this is the first BN model developed for the identification of acute appendicitis incorporating imaging variables. It has particular benefit for cases in which variables are missing because prior probabilities are built into corresponding nodes. It will be of use to clinicians involved in ultrasound examination of children with suspected appendicitis, as well as their treating clinicians. Prospective evaluation and development of an online tool will permit validation and refinement of the BN.

Justification of radiographic examinations: What are the key issues?

Justification of radiographic examinations is the practice of evaluating requested radiological examinations to assess for clinical merit and appropriateness based on clinical notes and patient information. This implies that justification in radiography requires the evaluation of requested examinations, the justification of exposures being applied and determining whether patients fit the recommended criteria for the procedure. Medico-legal requirements by the professional registration body, the Medical Radiation Practice Board of Australia (MRPBA), identify justification as an advocated and obligatory practice for radiographers. Yet, justification remains an inconsistent practice implemented amongst Australian radiographers. This review aims to identify associated barriers inhibiting the consistent practice of justification and the hesitance by radiographers in practicing justification responsibilities. It also recommends a change in workplace culture which encourages radiographers to accept a more autonomous role that cultivates critical thinking, reflection and research-informed decision making as justification will ultimately benefit patients.